Heartburn

Overview

Heartburn is a burning feeling that rises from your stomach up behind your breastbone. It happens when stomach acid flows back up into your food pipe (the oesophagus, the tube that carries food from your mouth to your stomach). Despite its name, heartburn has nothing to do with your heart. It is very common and most people get it now and then, especially after a big or spicy meal. It is often called acid reflux, and when it keeps happening regularly, doctors may call it GORD or GERD (gastro-oesophageal reflux disease).

Yes, it is extremely common. Most adults have heartburn at some point, and many people get it at least once a week. It is one of the most frequent reasons people ask a pharmacist or doctor for help.

Anyone can get heartburn, at any age. It is more common in people who are overweight, are pregnant, smoke, eat large or late meals, or drink a lot of alcohol or caffeine. Older adults and people taking certain long-term medicines are also more likely to be affected. Babies and children can have reflux too, though it usually settles as they grow.

Symptoms

Common symptoms

• A burning or warm feeling in the chest, usually behind the breastbone, often after eating
• The burning feeling gets worse when you lie down, bend over, or lie flat at night
• A sour or bitter taste in the back of your mouth
• A burning feeling in your throat, or a feeling that food is coming back up
• Burping, bloating, or feeling full quickly
• A hoarse voice, a dry cough, or a sore throat, especially in the morning
• Bad breath or a coating on the tongue
• Waking at night with a cough or a choking feeling

Symptoms in children

• Frequent spitting up or vomiting after feeds in babies — some reflux is normal in young babies
• Fussiness, crying, or arching the back during or after feeds
• Coughing, choking, or hiccupping during feeds
• Poor feeding or refusing food
• In older children: a burning chest feeling, a sour taste, or a long-lasting cough
• Children may say their tummy or chest hurts but not be able to describe burning

Symptoms in older adults

• Less obvious burning and more of a cough, hoarse voice, or throat clearing
• A feeling of food sticking or a lump in the throat
• Symptoms that are blamed on 'old age' or a chest infection
• More chance that chest pain could be caused by the heart, so new chest pain should always be checked
• Some long-term medicines can make reflux worse — ask your pharmacist or doctor to review your medicines

Causes

Main causes

• The valve (ring of muscle) at the bottom of your food pipe relaxes when it should stay closed, letting acid escape upward
• A hiatal hernia — part of the stomach pushes up through the diaphragm, which makes reflux more likely
• Eating large meals, or eating and then lying down or bending over soon afterwards
• Pressure on the stomach from being overweight or from pregnancy
• Certain foods and drinks, such as fatty or fried foods, spicy food, chocolate, mint, citrus, tomatoes, coffee, fizzy drinks, and alcohol
• Smoking, which weakens the valve and reduces protective saliva
• Some medicines, including certain pain relievers, asthma inhalers, and blood pressure or heart medicines — ask your pharmacist, but never stop a prescribed medicine without advice
• Stress and poor sleep, which can make symptoms feel worse

Risk factors

• Being overweight or carrying extra weight around the middle
• Being pregnant
• Smoking or using nicotine products
• Drinking a lot of alcohol
• Large, late, or fatty meals
• Drinking a lot of coffee, tea, or fizzy drinks
• Wearing tight belts or clothing around the waist
• A hiatal hernia
• Taking certain long-term medicines
• High stress levels and sleeping poorly

When to see a doctor

See a doctor urgently if:

• Chest pain that feels like pressure or squeezing, or comes with breathlessness, sweating, or feeling faint — call your local emergency number first
• Vomiting blood or material that looks like coffee grounds, or black tarry stools
• Trouble swallowing, or food getting stuck
• Losing weight without trying
• Severe or worsening pain in your chest or upper tummy
• These symptoms in a child: poor weight gain, refusing feeds, forceful vomiting, or blood in vomit

Book a routine appointment if:

• Heartburn most days, or symptoms that keep coming back after self-care changes
• Symptoms that have not improved after two to three weeks of lifestyle changes and over-the-counter remedies
• You need to take remedies for heartburn most days
• A long-lasting cough, hoarse voice, or sore throat that will not settle
• Symptoms that wake you at night or affect your sleep and daily life
• New heartburn starting in someone over 55

Diagnosis

Most of the time, a doctor can tell that you have heartburn by asking about your symptoms and examining you. There is usually no need for tests if your symptoms are typical and nothing else seems wrong. If your symptoms are unusual, do not improve with treatment, or you have warning signs such as trouble swallowing or weight loss, your doctor may arrange further tests.

Tests that may be done

• A short trial of self-care changes and acid-reducing treatment, to see whether symptoms settle
• A test for Helicobacter pylori (a common stomach bacterium) using a breath or stool sample
• An endoscopy — a thin, flexible tube with a camera passed through your mouth to look at your food pipe and stomach, usually done with sedation
• A tube test to measure acid levels in your food pipe over 24 hours, used in some cases
• Blood tests, if other conditions need to be ruled out
• Heart tests, if your chest pain could be coming from your heart rather than your stomach

What to expect at your appointment

Your appointment will usually start with questions about when the burning happens, what makes it better or worse, what you eat and drink, your medicines, and whether you have any warning signs. A physical examination is common. If tests are needed, your doctor will explain why, what is involved, and how long results take. It is helpful to keep a short diary of your symptoms for a week or two before your visit.

Treatment

Treatment aims to reduce how often acid flows back up and to protect your food pipe from irritation. For most people, lifestyle changes plus a short course of an over-the-counter remedy from your pharmacist are enough. If symptoms keep coming back, your doctor may suggest a regular prescription medicine and check for other causes.

Self-care at home

• Eat smaller meals more often, rather than two or three very large ones
• Leave about three hours between your last meal and lying down
• Raise the head of your bed by 10 to 15 cm (on blocks or with a wedge pillow) rather than using extra pillows
• Keep a food diary to spot your own triggers and cut back on them — common ones include fatty foods, spicy food, chocolate, mint, citrus, tomatoes, coffee, and fizzy drinks
• Cut down on alcohol and stop smoking; ask your pharmacist or local stop-smoking service for help
• Lose some weight if you are carrying extra weight, even a small amount can help
• Loosen tight belts and waistbands, and avoid bending over straight after eating
• Chew sugar-free gum after meals — it makes more saliva, which helps clear acid
• Avoid eating late at night or having a large meal before bed
• Ask your pharmacist about over-the-counter remedies that neutralise acid or reduce acid production, and check they are safe with your other medicines

Medical treatments

Pharmacists and doctors can offer medicines that either neutralise stomach acid or reduce how much acid your stomach makes. Some are available without a prescription for short-term use, and others are prescribed for a longer course. Your doctor will choose based on how often you get symptoms, how severe they are, and your other health conditions and medicines. Always check with a pharmacist before combining remedies, and do not stay on over-the-counter treatments for a long time without medical advice — ongoing symptoms should be reviewed. If a medicine you already take seems to make heartburn worse, ask your doctor about alternatives rather than stopping it yourself.

When is surgery considered?

Surgery is only considered for a small number of people — for example, when symptoms are severe, keep coming back, and cannot be controlled with medicines and lifestyle changes, or when someone cannot or does not want to take long-term medicine. The most common operation tightens the valve at the bottom of the food pipe. Your specialist team would discuss the benefits and risks with you in detail. There are also non-surgical procedures offered in some centres for selected patients.

Living with this condition

Heartburn can be annoying and can disturb sleep, but it is manageable for most people. Learning your own triggers, eating a little earlier in the evening, and adjusting your sleep position often makes a big difference. Keep any remedies you use handy, and note when symptoms flare so you can spot patterns.

Lifestyle tips

• Eat at regular times instead of skipping meals and then eating a lot
• Keep a symptom and food diary for a couple of weeks
• Avoid lying down or doing vigorous exercise within two to three hours of a meal
• Wind down before bed — stress and late screen time can make reflux worse
• Wear comfortable clothing around your waist
• If you smoke, get support to stop; this is one of the most effective changes you can make
• Reduce alcohol, especially in the evening
• Raise the head of your bed if night symptoms are a problem

Diet and exercise

There is no single 'reflux diet' that works for everyone, but many people find that smaller portions, less fried and fatty food, and fewer very spicy meals help. Caffeine, fizzy drinks, chocolate, and mint are common triggers — try cutting one out at a time to see if it matters for you. Regular gentle-to-moderate activity such as walking, swimming, or cycling supports healthy weight and digestion. Try to avoid vigorous exercise straight after eating, and stay well hydrated. If a particular food reliably sets off your symptoms, you may want to limit it rather than cut it out completely.

Mental health and emotional wellbeing

Living with a recurring symptom can be tiring and can affect sleep, work, and mood. Stress and anxiety do not cause heartburn, but they can make it feel worse — and ongoing discomfort can in turn raise stress. Breathing exercises, gentle activity, good sleep habits, and talking to someone can all help. If your mental health is affecting your daily life, please speak to your doctor. If you ever feel you cannot cope or have thoughts of harming yourself, contact a crisis support line or emergency service in your country straight away — you deserve help and you are not alone.

Prevention

You cannot always prevent heartburn, but you can greatly reduce how often it happens. Keeping a healthy weight, eating smaller meals, avoiding your personal trigger foods, limiting alcohol, not smoking, and not lying down soon after eating are the changes that help most. If a medicine you take seems to trigger it, ask your doctor or pharmacist about alternatives.

Complications

If left untreated

• Oesophagitis — soreness and inflammation of the food pipe from repeated acid exposure
• Narrowing of the food pipe, which can make swallowing difficult
• Barrett's oesophagus — a change in the lining of the food pipe that slightly raises the risk of cancer of the food pipe and needs monitoring
• An ulcer or bleeding in the food pipe
• Long-term cough, hoarse voice, or throat irritation
• Poor sleep and reduced quality of life
• Dental problems from repeated acid in the mouth
• In children, poor feeding and slow weight gain if reflux is severe

Long-term outlook

For most people, heartburn is uncomfortable but not dangerous, and it improves with simple changes and short-term treatment. Even when symptoms are frequent, they can usually be well controlled. The small number of people who develop complications are usually found and treated early, which is exactly why ongoing or unusual symptoms are worth checking. Most people find a routine that keeps symptoms manageable and get on with normal life.

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